Frequently Asked Questions about Weight Loss Sugery

The following are questions that are often asked about weight loss surgery. In addition to this information, one of the best steps to take if you curious about weight loss surgery and whether it's right for you is to attend an information session held by the surgeons who perform weight loss surgery at WakeMed Cary Hospital. Their web sites list upcoming sessions, and their office staff can provide you with information, as well.

Frequently Asked Questions

What is weight loss (bariatric) surgery?Weight loss surgery, also called bariatric surgery, limits the amount of food the stomach can hold, or limits the absorption of nutrients, causing the patient to lose a considerable amount of weight.

Who should have weight loss surgery?Persons who are extremely obese may want to consider weight loss surgery when traditional attempts at dieting and weight loss programs have failed. Weight loss surgery candidates are at least 100 pounds overweight. This translates to a body mass index (BMI) of 40 or over. Sometimes, patients with a BMI of 35 and over are considered for surgery if they have medical problems that are caused by or associated with obesity, such as diabetes, high blood pressure, and heart disease.What are my options for weight loss surgery? The two most common operations are adjustable gastric banding and gastric bypass. At WakeMed Cary Hospital, a sleeve gastrectomy also is performed. These procedures reduce the size of the area in the stomach where food collects.

Whenever possible, your bariatric doctor will conduct laparoscopic surgery, which is less invasive than open surgery, so patients usually have less discomfort, a shorter recovery time and fewer complications. Your surgeon will help you make the best decision after a careful evaluation.

How much weight can I expect to lose? That depends on the individual patient and the procedure used. With the adjustable gastric banding procedure, weight loss progresses steadily over a two- to three-year period and then stabilizes. The final result is usually between 50 and 60 percent of the excess weight. After four years, studies show the level of weight loss is equal to that achieved by gastric bypass surgery.

After gastric bypass surgery, weight loss usually exceeds 100 pounds or up to 70 percent of the excess body weight, but it generally levels off in one to two years. It is common for patients to regain up to 10 percent of their excess body weight. Your surgeon will work with you to determine your recommended weight goal, based on your height and other factors.

Are there any risks associated with weight loss surgery?Just about every type of surgery carries risks and possible complications. Potential risks and complications after gastric bypass include:

Vomiting or nausea

Dumping syndrome

Nutritional deficiencies

Gallstones

Diarrhea

Increased gas or constipation

Potential risks and complications after gastric banding include:

Migration of implant, which includes band erosion, band slippage, and port displacement

Tubing related complications, which include port disconnection and tube kinking

Port site infection

Abdominal hernia

Constipation

Nausea

How much do these procedures cost?Weight-loss procedures cost from $15,000 to $35,000. Medical insurance will cover the surgery for many patients, but coverage varies by state and insurance provider.

How do I know if my physician is qualified?Find out how many years of experience he/she has in the field, the number of operations he/she has performed and how many times he/she has performed a specific procedure. The surgeon you choose should be experienced with the procedure you are considering. You should also determine if they are board-certified, and if they are members of the American Society of Metabolic and Bariatric Surgery. (WakeMed Cary Hospital's bariatric doctors are highly experienced, board-certified, and most are members of the ASMBS.)

Also, discuss their commitment to follow-up, because weight loss surgery is just the first step on your journey to a fuller and healthier life. You will want to be sure your care team offers guidance and support in nutrition, exercise and other areas.

How long will it take me to recover after surgery?That depends on the procedure and the patient. Some patients are eligible for discharge on the same day as surgery, while in other cases, a patient may need to stay overnight or for a few nights. Patients generally return to normal activity in about one week after laparoscopic adjustable gastric banding and two to three weeks after laparoscopic gastric bypass.

What can I eat after surgery?Immediately following adjustable gastric banding, only sips of water are allowed. Over the next two weeks, patients gradually increase fluids to include clear broth, skim milk, low-calorie juice and sugar-free ice pops. After three to four weeks, low-fat pureed foods, mashed potatoes and protein-rich items like chicken and fish are added. Patients who undergo gastric bypass follow a similar progression for 12 weeks and then they are allowed regular, healthy foods. If you are taking medications, you may need to crush your pills or find out if they come in liquid form to make them easier to take in the first weeks following surgery. Your Care Team will work closely with you about the types of food you can eat and when, and will also determine whether vitamin supplements are needed.

Will weight loss surgery improve my health?Weight loss surgery can eliminate or improve most obesity-related medical complications, including diabetes, hypertension, high cholesterol, sleep apnea, reflux and osteoarthritis, as well as stress incontinence, dermatitis, muscle and joint pain. Most patients are able to exercise much better, which helps them feel more energetic. Many patients also report feeling better emotionally, with less depression as their health and body image improves.

What will my lifestyle be like after surgery?Lifetime follow-up with your bariatric doctors is recommended, with at least three follow-up visits during the first year. Adjustable gastric banding requires more frequent visits for band adjustments. You will need to adopt a healthy lifestyle, including a new nutrition plan and regular exercise. You will be strongly encouraged to join a support group or find other ways to meet your changing emotional needs. Remember, Bariatric surgery is not cosmetic surgery. You must commit to long-term lifestyle changes, including diet and exercise, which are keys to the success of bariatric surgery.

How can I find other people who have experienced this surgery to talk to?One way to be successful is by talking openly with others who are dealing with the same types of issues as you. Support groups provide a safe, comfortable place to talk, share problems and solutions, and encourage each other.WakeMed Cary Hospital hosts a support group for bariatric patients. All potential and post-operative patients and their families are invited to attend these meetings, which are facilitated by healthcare professionals. Learn more about the Weight Loss Surgery Support Group.

Can I get pregnant after weight loss surgery?It is strongly recommended that women wait at least one year after the surgery before a pregnancy. Approximately one year post-operatively, your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished fetus. You should consult your surgeon as you plan for pregnancy.

Won't I have a lot of excess skin after I lose this much weight? Many people heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can "snap back." Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. Ask your surgeon about your need for a skin removal procedure.

If you do need or want further surgery, Cary Hospital has several experienced plastic surgeons on its medical staff who perform procedures at the hospital. For more information, visit our web site at www.wakemed.org or call the "Doctor Choice" physician referral line at 919-350-8900.

What should I do to get ready for weight loss surgery?The first step is to learn as much as you can about the obesity, the surgery and the lifestyle changes required to be successful after weight loss surgery.

You also will need to organize your medical records, including your diet history and prior weight loss attempts. Many insurance companies demand proof that nonsurgical methods of weight loss have been tried and failed before approving your request for surgery, so try to collect as much documentation as possible to submit to your insurance company. Your Care Team can help you with this process, and with filing your insurance.

Thirty days is the standard time for an insurance provider to respond to your request. You should initiate a follow-up phone call with them if you have not heard from them in that time frame.

Finally, if your insurance company will still not pay for your surgery and you have made up your mind to go ahead with surgery, you do have the option of paying out-of-pocket. You will want to make sure to take all potential costs into consideration, including tests and lab fees, psychiatric counseling, wellness programs, and the potential for complications that may require further medical procedures.